Impact of Brain Injury Often Overlooked in Driver’s Ed

April 16, 2005 -- What happens when the human head slams against the windshield at 65+ MPH? Ask a teenager to answer the question but prepare for an eye roll and commentary: “Sucks to be him.” Yes, it does ‘suck’ to suffer a brain injury, Ms. Rutter agrees. After all, she worked in a neuro-rehab for over eight years and witnessed the devastation firsthand.

“ Given the large toll of TBI and absence of a cure, prevention is of paramount importance. ”

Ms. Rutter recalls an exercise in orientation her first week of working at the center in 1996. The instructor requested the trainees to write 4 items on a blank sheet of paper: One childhood memory, one major accomplishment, where they were now in their lives (married, children, or college) and one future goal. Then she told them to squash the sheet of paper and toss it to the center of the table. She then asked, “How does it feel to throw away all you’ve accomplished? You’ve diminished your past, trashed your future, and there in that heap is a total loss of the person you once were, and what you might have achieved.” After an awkward silence, she continued, “That is what the clientele here have experienced. In the blink of an eye, they have lost everything. Many have forgotten tasks we take for granted, from tying our shoes to remembering to use the toilet. Short-term memory loss will cause them to forget what they had for breakfast…or even that they already ate breakfast. Frontal lobe injury causes impulsivity. Some become sexually uninhibited. You will discover that many folks become aggressive at the least provocation…”

about drugs and alcohol and how driving under the influence can take lives, but do they know what happens when accident victims survive? Fractured bones heal after splinted. Stitched lacerations merely leave a scar within a few weeks. Internal injuries require surgery, hopefully with a good outcome. Spinal injuries often immobilize the patient for months, possibly for life. As devastating as that is, it does not rival the worst case scenario; brain injury. The injured brain cannot heal like skin, tissue, or bone.

The statistics are daunting. Quoted from internet research is the following: “Traumatic brain injury (TBI), broadly defined as brain injury from externally inflicted trauma, may result in significant impairment of an individual's physical, cognitive, and psychosocial functioning. In the United States, an estimated 1.5 to 2 million people incur TBI each year, principally as a result of vehicular incidents, falls, acts of violence, and sports accidents. The number of people surviving TBI with impairment has increased significantly in recent years, which is attributed to faster and more effective emergency care, quicker and safer transportation to specialized treatment facilities, and advances in acute medical management. TBI affects people of all ages and is the leading cause of long-term disability among children and young adults.

Traumatic Brain Injury is more than twice prevalent in males than in females. The highest incidence is among persons 15 to 24 years of age and 75 years and older, with an additional less striking peak in incidence in children ages 5 and younger. Approximately 50 percent of TBIs are the result of motor vehicle, bicycle, or pedestrian-vehicle incidents. Safety belts, air bags, infant and child car seats, as well as changes in speed limits, road design, and traffic control have reduced motor vehicle-related deaths and TBI.”

Not too long ago, Joy learned first hand the importance of buckling up after her youngest, now sixteen acquired his license in January, 2005. Two weeks later, he hit a patch of black ice on a sharp curve and totaled his car. Fortunately, he wore his seatbelt and suffered no injury, not even a scratch. Rutter is grateful she had taught her boys to buckle up from infancy.

“Since TBI may result in lifelong impairment of an individual's physical, cognitive, and psychosocial functioning and prevalence is estimated to be 2.5 million to 6.5 million individuals, TBI is a disorder of major public health significance. Furthermore, mild TBI is significantly under diagnosed, and the likely societal burden therefore is even greater. Given the large toll of TBI and absence of a cure, prevention is of paramount importance.

Although TBI may result in physical impairment, the more problematic consequences involve the individual's cognition, emotional functioning, and behavior. These impact interpersonal relationships, school

So how do the schools teach the cause and effect of a TBI? Ms. Rutter suggests the following:
1.
Professionally videotape a small group of young TBI clients talking candidly of their experience and its effects in their lives and personal relationships. (For privacy, blur facial features and distort the voice). The tape should be readily available to US middle and high schools.
2.
If there is little room in the curriculum, assign driver’s education

students to research TBI (acquired in vehicular accidents) over the internet and turn in a report at the end of the semester.
3.
Invite a behavior specialist or occupational therapist from a local neuro-rehab to speak to the students. He or she not only has the education and background, but the day-to-day experience with victims of neurological disabilities.

Joy Lee Rutter’s novel, “A Flamboyant Disarray of Dreams” is not a textbook; however it offers powerful insight into the day in the life of not only the brain injured, but the caretaker of the clients in a neuro-rehab facility.

Summary:
Joleen Cumberland questions her motives for continuing her work at Rivers Edge, a neuro-rehabilitation center. She loses her focus, often endangering herself and her peers. She has reached the limits of her endurance.

Her work centers on clients, Alex Williams and Mitch Stevens. Mitch, unable to communicate because of his own brain injury, becomes intrigued by the spirited Alex. What is behind the rage Alex often displays? How will Mitch be able to communicate what he eventually learns?

Round Table Review: Reviewed By Wendall Sexton
Fascinating. My first reaction reading the initial pages opening Joy Lee Rutter’s "A Flamboyant Disarray of Dreams" was, as Mr. Spock might proclaim -- fascinating. A woman sits catatonic in her driveway, pondering death by the hand of Bart Simpson, while reflecting on her work, her life, and whether the patients she helps at Rivers Edge, a New Hampshire neuro-rehabilitation facility, are being “helped” by her efforts. Will their lost cognitive skills, necessary for assimilating information and controlling behavior, once more be of use; or are those patients, and their frenetic, dangerous childlike behaviors, dragging her down into the same disarray that fills their days? Such is the question before Joleen Cumberland.

I was drawn to this book initially from its title. It caught my attention, and I found myself wanting to know more of what this curious arrangement of words meant. When I learned the premise of the book took place in a ‘neuro-rehabilitation’ facility – a place of which I was unfamiliar – I knew there was something within its 281 pages worth investigating. Happily, I can report my time was spent well.

Why do I say this? Simple: "A Flamboyant Disarray of Dreams" resonates within the context of the Rivers Edge patients, as well as the staff from whom they depend for care.

You see, Joy Lee Rutter has accomplished something with this book all authors should. She has taken the book’s title, which overtly pertains to the disarray of those people robbed of their faculties, and applied it to the struggles all people encounter in their lives.